Confusing test results

[setay_k]

Hi,

In November I increased my dosage from 75/100mg alternating daily, to 100/125mg alternating daily. This was based on my extreme exhaustion.

12 November 2019: My previous results on 75/100mg alternating were:

CRP HS0.4 mg/L(Less than 5)

Ferritin135ug/L(13-150)

Folate (serum)11.48ug?L(More than 3.89)

Vit B12 Active110 pmol/L(More than 37.5)

Vit D82.6 nmol/L(50-175)

TSH2.53 mlU/L(0.27-4.2)

Free T34.73 pmol/L(3.1-6.8)

Free T417.100 pmol/L(12-22)

Thyroglobulin antibodies14.1 klU/L(Less than 115)

Thryoid peroxidase antibodies202 klU/L(Less than 34)

My results from a couple of days ago (03 March 2020) after increasing my medication on the 29th November to 100/125mg are now:

CRP HS0.45 mg/L(Less than 5)

Ferritin130ug/L(13-150)

Folate (serum)11.88ug/L(More than 3.89)

Vit B12 Active121 pmol/L(More than 37.5)

Vit D80.6 nmol/L(50-175)

TSH0.074 mlU/L(0.27-4.2)

Free T34.49 pmol/L(3.1-6.8)

Free T422.2 pmol/L(12-22)

Thyroglobulin antibodies13.9 klU/L(Less than 115)

Thryoid peroxidase antibodies176 klU/L(Less than 34)

Looking at the above, it looks like my TSH has been suppressed almost completely. (I believe under 1 is the goal?). And my Free T4 has increased nicely to above 22. However... my Free T3 has actually decreased?

Symptoms wise, I do feel better than I did in November, but do still get an afternoon slump. I don't have any noticeable symptoms of being overmedicated - I'm sleeping well etc. If anything I'm still cold!

Has anyone ever seen results like this?

Many thanks in advance for any suggestions.

[greygoose]

Perfectly normal that your FT3 has reduced, because your FT4 has now reached the point where the T4 is converting to more rT3 than T3. This is just a safety valve to prevent excessive FT3.

It might have been better to increase to 100 mcg daily. However, as you have Hashi's, the rapid increase in FT4 might not be entirely due to your increase in dose. Levels do tend to jump around with Hashi's. So, how do you feel on this new dose? Do you feel any better?

If not, if I were you, I'd go down to 100 mcg daily and retest after six weeks, and see what happens. And how you feel.

[setay_k in reply to greygoose]

Hi Greygoose,

Thanks for the reply. I do feel a bit better on this new dose. I've been able to do things after work which I was struggling for energy to do before. As mentioned, I still get an afternoon slump but I think this is pretty normal.

I had thought that T3 was the active form that I needed to increase? If I decreased my levels of Levo to 100mcg do you think less rT3 would be produced and my T3 would increase?

Thanks

[greygoose in reply to setay_k]

T3 is the active form and you do need to increase it if you feel it's too low. But, if you increase levo by too much, you conversion will decrease and therefore your FT3 will decrease, as I explained about.

If your decrease your levo slightly so that your FT4 reduces slightly, the odds are that your FT3 will rise slightly. Whether it will rise by enough is anyone's guess. If it doesn't, you have two choices: a) continue to raise levo until your FT3 does rise - but it might have to be well over-range to give you the level of FT3 you need; b) source some T3 and add that in.

[setay_k in reply to greygoose]

Thanks grey goose, I will try dropping back to 100mcg and see how I get on.

[greygoose in reply to setay_k]

You're welcome.

[setay_k]

Hi,

Looking for advice really. I tried dropping my levo back down to just 100mcg but ended up feeling worse, so I've upped it back to 100mcg/125mcg per day. But still not feeling good - I feel low, snappy, easily irritated, low on energy and just not me.

Do you recommend any threads on how to source T3? I don't think the NHS is going to have any time to see me at this critical point! Are there any ways of getting on private endocrinologists books?

Thanks